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5.55 AN OBJECTIVE MEASURE OF SPLITTING IN PARENTAL ALIENATION: THE PARENTAL ACCEPTANCE–REJECTION QUESTIONNAIRE
NEW RESEARCH POSTERS 5.54 – 5.56
with decreased mental ill-health at age 11 years (beta: -0.32, 95% CI: -0.58 to -0.06, p¼0.01). Conclusions: Different approaches to discipline appear to have a differential impact on later child mental health. Specifically, ‘withdrawal’ techniques appear protective against adverse mental health outcomes with long term impact. If proved to be replicable these findings hold implications for parenting practice and may help inform future parenting interventions.
DEV EC PAT http://dx.doi.org/10.1016/j.jaac.2016.09.311
5.54 PSYCHIATRIC CHARACTERISTICS OF DOMESTIC MINOR SEX TRAFFICKING PATIENTS: A COMPARATIVE RETROSPECTIVE ANALYSIS OF MEDICAL PRESENTATION Jessica Moore, BA, Pediatrics, Hasbro Children’s Hospital, 593 Eddy Street, Providence, RI 02903; Priyadarshini Hirway, ScM; Christine Barron, MD; Amy Goldberg, MD Objectives: The objective is to examine the demographic, social-environmental, and psychiatric characteristics of patients referred to medical providers for evaluation of domestic minor sex trafficking (DMST) compared with a matched sample of patients evaluated for acute sexual assault (ASA) who were not sexually exploited. The goal is to inform future medical practice of the historic and current psychiatric features that distinguish DMST patients from ASA patients. Methods: Medical records of patients aged 11-18 years who were referred for DMST evaluation at a child protection clinic or a pediatric emergency department, between August 1, 2013 and June 1, 2016, were retrospectively reviewed (n¼62). The sample was compared with gender and age-matched patients with a discharge diagnosis suggestive of ASA between January 1, 2010 and December 31, 2013 (n¼184). Patient information was obtained using REDCap database designed to capture patient variables. Data was analyzed using STATA. Results: Differences in demographic, social-environmental, and psychiatric factors were identified between the DMST and ASA groups. In both groups, most patients were female (>95%). However, patients in the DMST group were significantly older than in the ASA group (15.5 years vs.11.1 years, p<0.001). We also observed differences in race/ethnicity, as more patients in the DMST group were Non-Hispanic Black, and more patients in the ASA group were of other/Hispanic ethnicities (p<0.001). Significantly higher rates of prior child maltreatment among DMST patients were identified. Of these, prior sexual abuse (48.4% vs 12.5%, p<0.001) and exposure to domestic violence (24.2% vs 5.4%, p<0.001) had the largest difference. There was also a greater burden of psychiatric admissions and conditions (e.g. self-injurious behavior, 54.8% v 14.1% and suicidal ideation, 40.3% vs. 18.5%, p<0.001) among the DMST patients. Conclusions: Children who are either being victimized or are suspected of DMST involvement 1) present frequently for psychiatric assessment and attention; 2) have significant acute and historic psychiatric issues in comparison to ASA victims. These data support the need to include psychiatric assessment into DMST evaluations and broader screening for DMST involvement in patients who present for psychiatric care.
ADOL CAN R Supported by the Fleet Scholarship grant, 101-6345 http://dx.doi.org/10.1016/j.jaac.2016.09.312
5.55 AN OBJECTIVE MEASURE OF SPLITTING IN PARENTAL ALIENATION: THE PARENTAL ACCEPTANCE–REJECTION QUESTIONNAIRE William Bernet, MD, Psychiatry, Vanderbilt University, 1313 21st Ave S, 209 Oxford House, Nashville, TN 37232-0001; € Nilgun Ongider-Gregory, PhD; Kathleen Reay, PhD; Ronald P. Rohner, PhD
J OURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
Objectives: Both clinicians and forensic practitioners should distinguish parental alienation (rejection of a parent without legitimate justification) from parental estrangement (rejection of a parent for a good reason). Alienated children, who were not abused, engage in splitting and lack ambivalence with respect to the rejected parent; estranged children, who were maltreated, usually perceive the abusive parent in an ambivalent manner. The purpose of this study was to assess the usefulness of the Parental AcceptanceRejection Questionnaire (PARQ) in identifying and quantifying the degree of splitting, which assists in distinguishing parental alienation from realistic estrangement. Methods: Participants were 116 children, age 9 through 17, who constituted the following groups: children from intact families; children of divorced parents, who saw both parents on a regular basis; estranged children of divorced parents, who rarely or never saw one of the parents; and alienated children of divorced parents, who were identified by mental health experts and family courts as manifesting severe parental alienation. The children were administered the PARQ: Father and PARQ: Mother. Results: For the children alienated from their fathers, the PARQ: Mother scores were very low (Mean ¼ 64.67, SD ¼ 8.43) and the PARQ: Father scores were very high (Mean ¼ 231.88, SD ¼ 6.43). For the children alienated from their mothers, the PARQ: Mother scores were very high (Mean ¼ 212.52, SD ¼ 26.68) and the PARQ: Father scores were very low (Mean ¼ 67.86, SD ¼ 8.92). The PARQ showed that severely alienated children engaged in a high level of splitting, by perceiving the preferred parent in extremely positive terms and the rejected parent in extremely negative terms. Since splitting was not manifested by the estranged children, one can conclude that the PARQ effectively distinguished estranged children from alienated children. Conclusions: The PARQ is useful for both clinicians and forensic practitioners in evaluating children of divorced parents, when there is a concern about the possible diagnosis of parental alienation.
ATTACH DV FCP http://dx.doi.org/10.1016/j.jaac.2016.09.313
5.56 ANTIPSYCHOTIC MEDICATION PRESCRIPTION TRENDS IN FOSTER CARE CHILDREN ENROLLED IN ARKANSAS MEDICAID FOLLOWING IMPLEMENTATION OF PRIOR AUTHORIZATION POLICIES Stacy Simpson, MD, Psychiatry, Arkansas State Hospital, 305 South Palm, Little Rock, AR 72205; Steven Domon, MD; Laurence H. Miller, MD; Pamela Ford-Bowen, PharmD; William Golden, MD; Purushottam Thapa, MD Objectives: The growing trend in prescription of antipsychotic medications, especially the second generation antipsychotics (SGA), in children <18 years of age is of concern despite limited evidence of its effectiveness and associated adverse effects. Children in foster care are particularly vulnerable and are 7 times more likely to be prescribed a SGA. The present study evaluates the impact of PA strategies to reduce inappropriate prescription of SGAs in foster care children enrolled in ARMedicaid. Methods: In July 2009, AR-Medicaid established a PA process requiring manual review by a psychiatrist of SGA prescriptions 1) where >1 SGA was prescribed, and 2) in all children <5 years of age. In November 2011, the PA additionally required providers to obtain informed consent and implement metabolic monitoring for all new patients prescribed a SGA. In June 2012, this requirement was extended to all established patients on a SGA. Medicaid claims databases were used to evaluate the proportion of children who were prescribed a SGA from October 2006 through October 2014. Results: In October of 2006 and 2014, respectively, 5,660 and 7,790 children in foster care were enrolled in AR-Medicaid. Overall, there was a 47.1 percent decrease in foster care children prescribed a SGA between
www.jaacap.org
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with decreased mental ill-health at age 11 years (beta: -0.32, 95% CI: -0.58 to -0.06, p¼0.01). Conclusions: Different approaches to discipline appear to have a differential impact on later child mental health. Specifically, ‘withdrawal’ techniques appear protective against adverse mental health outcomes with long term impact. If proved to be replicable these findings hold implications for parenting practice and may help inform future parenting interventions.
DEV EC PAT http://dx.doi.org/10.1016/j.jaac.2016.09.311
5.54 PSYCHIATRIC CHARACTERISTICS OF DOMESTIC MINOR SEX TRAFFICKING PATIENTS: A COMPARATIVE RETROSPECTIVE ANALYSIS OF MEDICAL PRESENTATION Jessica Moore, BA, Pediatrics, Hasbro Children’s Hospital, 593 Eddy Street, Providence, RI 02903; Priyadarshini Hirway, ScM; Christine Barron, MD; Amy Goldberg, MD Objectives: The objective is to examine the demographic, social-environmental, and psychiatric characteristics of patients referred to medical providers for evaluation of domestic minor sex trafficking (DMST) compared with a matched sample of patients evaluated for acute sexual assault (ASA) who were not sexually exploited. The goal is to inform future medical practice of the historic and current psychiatric features that distinguish DMST patients from ASA patients. Methods: Medical records of patients aged 11-18 years who were referred for DMST evaluation at a child protection clinic or a pediatric emergency department, between August 1, 2013 and June 1, 2016, were retrospectively reviewed (n¼62). The sample was compared with gender and age-matched patients with a discharge diagnosis suggestive of ASA between January 1, 2010 and December 31, 2013 (n¼184). Patient information was obtained using REDCap database designed to capture patient variables. Data was analyzed using STATA. Results: Differences in demographic, social-environmental, and psychiatric factors were identified between the DMST and ASA groups. In both groups, most patients were female (>95%). However, patients in the DMST group were significantly older than in the ASA group (15.5 years vs.11.1 years, p<0.001). We also observed differences in race/ethnicity, as more patients in the DMST group were Non-Hispanic Black, and more patients in the ASA group were of other/Hispanic ethnicities (p<0.001). Significantly higher rates of prior child maltreatment among DMST patients were identified. Of these, prior sexual abuse (48.4% vs 12.5%, p<0.001) and exposure to domestic violence (24.2% vs 5.4%, p<0.001) had the largest difference. There was also a greater burden of psychiatric admissions and conditions (e.g. self-injurious behavior, 54.8% v 14.1% and suicidal ideation, 40.3% vs. 18.5%, p<0.001) among the DMST patients. Conclusions: Children who are either being victimized or are suspected of DMST involvement 1) present frequently for psychiatric assessment and attention; 2) have significant acute and historic psychiatric issues in comparison to ASA victims. These data support the need to include psychiatric assessment into DMST evaluations and broader screening for DMST involvement in patients who present for psychiatric care.
ADOL CAN R Supported by the Fleet Scholarship grant, 101-6345 http://dx.doi.org/10.1016/j.jaac.2016.09.312
5.55 AN OBJECTIVE MEASURE OF SPLITTING IN PARENTAL ALIENATION: THE PARENTAL ACCEPTANCE–REJECTION QUESTIONNAIRE William Bernet, MD, Psychiatry, Vanderbilt University, 1313 21st Ave S, 209 Oxford House, Nashville, TN 37232-0001; € Nilgun Ongider-Gregory, PhD; Kathleen Reay, PhD; Ronald P. Rohner, PhD
J OURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
Objectives: Both clinicians and forensic practitioners should distinguish parental alienation (rejection of a parent without legitimate justification) from parental estrangement (rejection of a parent for a good reason). Alienated children, who were not abused, engage in splitting and lack ambivalence with respect to the rejected parent; estranged children, who were maltreated, usually perceive the abusive parent in an ambivalent manner. The purpose of this study was to assess the usefulness of the Parental AcceptanceRejection Questionnaire (PARQ) in identifying and quantifying the degree of splitting, which assists in distinguishing parental alienation from realistic estrangement. Methods: Participants were 116 children, age 9 through 17, who constituted the following groups: children from intact families; children of divorced parents, who saw both parents on a regular basis; estranged children of divorced parents, who rarely or never saw one of the parents; and alienated children of divorced parents, who were identified by mental health experts and family courts as manifesting severe parental alienation. The children were administered the PARQ: Father and PARQ: Mother. Results: For the children alienated from their fathers, the PARQ: Mother scores were very low (Mean ¼ 64.67, SD ¼ 8.43) and the PARQ: Father scores were very high (Mean ¼ 231.88, SD ¼ 6.43). For the children alienated from their mothers, the PARQ: Mother scores were very high (Mean ¼ 212.52, SD ¼ 26.68) and the PARQ: Father scores were very low (Mean ¼ 67.86, SD ¼ 8.92). The PARQ showed that severely alienated children engaged in a high level of splitting, by perceiving the preferred parent in extremely positive terms and the rejected parent in extremely negative terms. Since splitting was not manifested by the estranged children, one can conclude that the PARQ effectively distinguished estranged children from alienated children. Conclusions: The PARQ is useful for both clinicians and forensic practitioners in evaluating children of divorced parents, when there is a concern about the possible diagnosis of parental alienation.
ATTACH DV FCP http://dx.doi.org/10.1016/j.jaac.2016.09.313
5.56 ANTIPSYCHOTIC MEDICATION PRESCRIPTION TRENDS IN FOSTER CARE CHILDREN ENROLLED IN ARKANSAS MEDICAID FOLLOWING IMPLEMENTATION OF PRIOR AUTHORIZATION POLICIES Stacy Simpson, MD, Psychiatry, Arkansas State Hospital, 305 South Palm, Little Rock, AR 72205; Steven Domon, MD; Laurence H. Miller, MD; Pamela Ford-Bowen, PharmD; William Golden, MD; Purushottam Thapa, MD Objectives: The growing trend in prescription of antipsychotic medications, especially the second generation antipsychotics (SGA), in children <18 years of age is of concern despite limited evidence of its effectiveness and associated adverse effects. Children in foster care are particularly vulnerable and are 7 times more likely to be prescribed a SGA. The present study evaluates the impact of PA strategies to reduce inappropriate prescription of SGAs in foster care children enrolled in ARMedicaid. Methods: In July 2009, AR-Medicaid established a PA process requiring manual review by a psychiatrist of SGA prescriptions 1) where >1 SGA was prescribed, and 2) in all children <5 years of age. In November 2011, the PA additionally required providers to obtain informed consent and implement metabolic monitoring for all new patients prescribed a SGA. In June 2012, this requirement was extended to all established patients on a SGA. Medicaid claims databases were used to evaluate the proportion of children who were prescribed a SGA from October 2006 through October 2014. Results: In October of 2006 and 2014, respectively, 5,660 and 7,790 children in foster care were enrolled in AR-Medicaid. Overall, there was a 47.1 percent decrease in foster care children prescribed a SGA between
www.jaacap.org
S201